Abstract

BACKGROUND: Low-intensity extracorporeal shock wave therapy (Li-ESWT) has been introduced as a treatment for penile diseases. Its impact on testicular function during treatment remains unknown OBJECTIVES: To clarify whether Li-ESWT impairs testicular function during the treatment of penile diseases by investigating the impact of Li-ESWT on testosterone synthesis and spermatogenesis in adult rats. MATERIALS AND METHODS: Twenty-four male Sprague-Dawley rats were equally divided into the following three groups: control group, 1.6 BAR group, and 3.2 BAR group. Rats in the experimental groups were treated with Li-ESWT at different energy levels (300 shocks at 1.6 BAR or 3.2 BAR, 2 Hz frequency) three times a week for 3 weeks. The control group did not receive any treatment during the same period of time. One day after the last shock wave treatment, serum and testicular tissue testosterone concentrations were measured, and sperm quality was assayed. Histologic examination of the testes and quantitative real-time PCR were performed. RESULTS: Testosterone levels in both the serum and testicular tissue did not change after Li-ESWT exposure. The expression levels of steroidogenic enzymes (steroidogenic acute regulatory protein (StAR), cytochrome P450 cholesterol side-chain cleavage enzyme (P450scc), and 3β-hydroxysteroid dehydrogenase (3β-HSD)) were not impacted by Li-ESWT. The 3.2 BAR group showed a significantly lower sperm count and lower expression of synaptonemal complex protein 3 (SYCP3) in testicular tissue than the control group. No significant differences in sperm quality or SYCP3 expression were observed between the control group and the 1.6 BAR group. CONCLUSION: Li-ESWT exposure at 3.2 BAR inhibited spermatogenesis and decreased sperm quality, which indicated that male patients with a desire to preserve fertility should undergo low-energy Li-ESWT or other treatment modalities.

Andrology. 2018 Aug 5. doi: 10.1111/andr.12534. [Epub ahead of print]

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Comments
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Do patients have to be informed about possible testicular damage while being treated with Li-ESWT? I would say, no: “…the use of animal experiments might raise the question of the applicability of these results to humans. The present study focused on the effects of Li-ESWT on testicular function in adult rats and should not be generalized to other conditions. Randomized, controlled, multicenter human studies are needed to determine whether testicular function is impacted during exposure to Li-ESWT.”
But it is difficult to fully imagine what lawyers might find worthy to launch a prosecution. Maybe manufacturers of Li-ESWT machines should offer their customers a small shock-wave protecting device to cover the testicles.

Do patients have to be informed about possible testicular damage while being treated with Li-ESWT? I would say, no: “…the use of animal experiments might raise the question of the applicability of these results to humans. The present study focused on the effects of Li-ESWT on testicular function in adult rats and should not be generalized to other conditions. Randomized, controlled, multicenter human studies are needed to determine whether testicular function is impacted during exposure to Li-ESWT.”
But it is difficult to fully imagine what lawyers might find worthy to launch a prosecution. Maybe manufacturers of Li-ESWT machines should offer their customers a small shock-wave protecting device to cover the testicles.